Dr Robert Caldwell with staff from the Church of
Scotland hospital in Tugela Ferry.

UKZN researchers have found that the appointment of a dedicated outreach consultant for a particular Discipline, together with a capable transport system, was successful in providing access to specialist care and that this strategy could be recommended throughout South Africa.

The researchers analysed the appointment of a dedicated Internal Medicine Outreach Consultant, Dr Robert Caldwell, in western KwaZulu-Natal from 2007-2014.

The research team comprised Caldwell, Dr Colleen Aldous and Dr Bernhard Gaede.

Funded by the KZN Department of Health (DOH) and facilitated by the Red Cross Air Mercy Service (AMS), Specialist Physician Caldwell was appointed from 2007 as an Outreach Consultant for the Pietermaritzburg (PMB) Department of Internal Medicine, to provide specialist cover for peripheral hospitals in western KZN.

During the period 2007 to mid-2014, Caldwell made 481 hospital visits, which included visiting seven hospitals (out of 21) more than 40 times each. A total of 3 340 medical personnel contacts were made, and 5 239 patients were seen. This involved almost 200 flights and 500 road trips.

Other internal medicine specialists from Pietermaritzburg undertook an additional 199 visits, during which they made 1 157 personnel contacts and saw 2 020 patients.

The planned visits to hospitals took place on a specific day of the week and were designed not to coincide with visits from other specialties. Visits were occasionally cancelled because of bad weather when travel took place in single turbo-prop Swiss Pilatus aeroplanes. An AMS road vehicle was provided where no suitable airstrip was available.

A typical visit to a remote hospital would include an early morning meeting which incorporated a teaching session, followed by a booked outpatients clinic, where doctors from the local hospital and a nurse/interpreter were required to be present.

A further component included a problem ward round of selected cases presented by the doctors concerned, where diagnosis, management and the need for referral were to be covered. In the seven and a half years, Caldwell was fortunate to be able to focus on this outreach work and attributed this to the large consultant numbers in Pietermaritzburg’s Department of Internal Medicine which afforded him the opportunity to concentrate on this field rather than to be involved in clinical work at the tertiary hospital.

Since his appointment was initially a full-time one, he was required to contribute to the running and welfare of the department and therefore was on the call roster, did ward rounds at Edendale Hospital, a PMB regional/district hospital, initiated a telemetry link to peripheral hospitals, and became co-ordinator of the elective medical student programme for internal medicine, such students often attending outreach visits.

Patients seen on outreach were those who might otherwise have required referral to the relevant regional or tertiary hospital. Only a minority of patients seen were referred, indicating that the intervention itself obviated the need for referral.

The researchers proposed that the appointment of a dedicated outreach consultant for a particular discipline, together with a capable transport system, was successful in providing access to specialist care and that this strategy could be recommended throughout South Africa.

In reflecting on his years working as an outreach specialist, Caldwell said: ‘The partnership between the KZN DOH and Red Cross AMS was inspirational and far sighted. One sincerely hopes that it continues, and that all consultants are encouraged to contribute to the outreach programme, in accordance with their job descriptions.’